Theresa May has stipulated that every child is to be weighed by default in her Plan for Action to tackle childhood obesity. That is very welcome. But, since the Plan’s announcement in August, there has been total silence on what “ default “ actually means. Neither Nr 10 nor the Department of Health or any of the Medical Royal Colleges * who might have been expected to be consulted on the issue appear to have any idea of the detail. That is plainly wrong. The National Obesity Forum believes that, after 4 months, it is high time that the small print was published to prove how much serious thinking on the Plan has been done.

Just explaining what “ default “ actually means would be helpful. If it means that every child is weighed every time it shows up for a medical check, that would be rubbish: on average a child comes into contact with a health professional some 50 times by the time it leaves school. If however it was weighed at set times in order to identify a concerning weight trend, the programme would be brilliant. After all, animals are weighed annually in zoos to check on their health and our cars get an MOT yearly once over, so why not our children? Without such a programme another stated objective in the Plan - the identification of weight issues early on – will not be achievable.

Weighing children is nothing new. Indeed, programmes were initiated over a hundred years ago but they were axed before childhood obesity ever became a serious problem. Currently a child is weighed a few times in its first year of life but hardly at all thereafter. The Forum holds the view that this omission, over many years, to a huge number of children with critical weight gain not being identified and referred for treatment. A quarter of our 4-5 yr old population didn’t get overweight or obese overnight. Their plight is, in the words of the Secretary of State, is a “ great scandal “ – and he could have added that it is one that he should have substantially attenuated..

It is not as if he and former Health Secretaries were left in any doubt as to what to do. In his 2002 Annual Report the Chief Medical Officer for England, Sir Liam Donaldson, called on all primary care professionals – GPs, health visitors, school nurses and the rest - to identify the early stages of childhood obesity and offer early interventions. By 2004 the House of Commons’ Health Select Committee [HSC] recommended to the government that every child in primary school to be assessed for BMI annually. Again in 2010 Donaldson recommended that schoolchildren have annual fitness tests and most recently Dr Sarah Wollaston, the current HSC chair, repeated the call by the predecessors. Indeed to-day’s HSC recommends that the public health survey taken at 4-5yrs be brought forward to one at aged 2yrs. In the opinion of the National Obesity Forum, a default weighing programme should be implemented as soon as possible at all these ages. Had they been when recommended, there is no doubt that tens of thousands of excessively overweight children would have been spotted and could have been helped not to drift into obesity.

The Plan for Action already has already provided the opportunity. In a separate provision it has directed schools from the 2017/18 academic year to begin to deliver 30 minutes of physical activity and what better than to assess fitness levels at the same time, too? Although the proper interpretation of BMI data might rightfully be the preserve of health professionals, the actual job of assessment could be carried out by any responsible adult once they have been trained to do it. The equipment required is inexpensive and the methodology uninvasive. Carried out properly the operation could induce a significant improvement in the country’s obesity figures,

Finally, and from 2017 too, physically activity will be a key part of the new healthy schools rating scheme. They will have the opportunity to demonstrate what they are doing to help their pupils become or stay healthy and fit. They will be encouraged to work with the school nurses, health centres, healthy weight teams in local authorities across the country. Ofsted inspections will keep them up to the mark. It’s a win-win situation – and about time, too.

*Royal College of Paediatrics, Royal College of General Practitioners, Royal College of Physicians’

Rt Hon Jeremy Hunt MPSecretary of State for HealthDepartment of HealthRichmond House79 WhitehallLondonSW1A 2NS11 January 2017

Dear Mr Hunt

We are writing this open letter to encourage you to elaborate on measures, set out in the Childhood Obesity Plan, for a default child weighing programme, or to launch a consultation with experts to determine how such an initiative could be best implemented.

Our belief is that such a programme could have a significant impact on levels of childhood obesity that remain dangerously high. It would allow early identification and intervention to prevent overweight and obesity in children that could affect their long-term health outcomes. And over time such a programme could ultimately help in counteracting obesity levels across the population as a whole, in turn reducing the cost of obesity to the NHS.

The inclusion of weighing children within the Childhood Obesity Plan was extremely welcome. While weighing children at every medical appointment would be excessive, an annual check would be in line with the recommendations of experts for annual child health checks, including those of former Chief Medical Officer Sir Liam Donaldson and Chair of the Health Select Committee Dr Sarah Wollaston.

With one in five children considered overweight or obese by the time they begin primary school, according to the National Child Measurement Programme, we would urge you to implement this part of the Childhood Obesity Plan with all haste. We believe this could be achieved at minimal cost but with great reward.

0001hrs, 9 January 2016. A third (34 percent) of Britons believe increasing the mandatory amount of time children spend on physical education in schools would be one of the most effective ways of helping to reduce levels of obesity, with a similar number (33 percent) favouring clearer labelling of food and drink products as the most effective way to tackle the UK obesity epidemic, according to a new ComRes poll commissioned for the annual JanUary healthy living campaign.

Schools in England are required to include PE within their curriculums, but are allowed to set the amount of time they spend on physical activity after a government target of two hours a week was scrapped in 2012.

The poll also found that, when asked to choose between a range of potential health measures, nearly a quarter of respondents (23 percent) thought a ban on advertising ‘junk’ foods before a watershed of 9pm would work best, with a similar percentage (24 percent) believing loyalty-style promotions by supermarkets would encourage the purchase of healthy products and be the most effective way of reducing obesity levels.

One in five Britons (21 percent) chose a ban on ‘Buy one get one free’ (Bogof) promotions, with the same percentage of respondents also believing reduced portion sizes and taxes on products high in salt, sugar and fat would be most effective in reducing obesity.

Nineteen percent of Britons called for more information from government on healthy food and drink. The poll was conducted to coincide with the launch of the annual JanUary campaign (formerly National Obesity Awareness Week), led by the National Obesity Forum and Heart Research UK, and calling on Britons to commit to healthy and sustainable New Year’s Resolutions for 2017.

Barbara Dinsdale, Head of Lifestyle at Heart Research UK, said:

“The scale of the obesity problem in the UK is well known, and puts a strain on public services, particularly the NHS.

“Ultimately, good habits and good choices are needed to address what is an epidemic. That needs to start in school, as well as in the home, and it’s essential children are encouraged to be physically active. But Britons also want to see clear information and to be incentivised to make healthy choices, whether through in-store promotions, smaller portions or better product labelling. There is an opportunity for the food and drink industry to build on the work it’s doing and to help customers make these healthy choices.”

Tam Fry, Spokesman for the National Obesity Forum, said:

“There is no quick fix to a problem that’s grown over more than 20 years. We need to encourage children to be more physically active and less wedded to computers, mobiles and television. And we need to ensure children and adults are encouraged to pick healthy foods, and discouraged from those high in sugar, salt and fats.”

Banning “buy one get one free” promotions in supermarkets on unhealthy products

21%

Extending the principle of the “Soft Drinks Industry Levy” and putting extra taxes on food products high in sugar, salt or fat to increase their cost

21%

More information from government on healthy food and drink

19%

None of these

11%

Don’t know

7%

Base: GB adults (n=2,031)

ComRes interviewed 2,031 GB adults online between 21 and 22 December 2016. Data was weighted to be demographically representative of all GB adults. ComRes is a member of the British Polling Council and abides by its rules.

For further information about the JanUary campaign, or comment from Heart Research UK, please contact Chris Rogers on 020 7793 2536 / 07720 054189.

Tam Fry from the National Obesity Forum is also available for interview and contactable on 07850 138822.

The Faculty of General Dental Practice (UK) says that a newly-published study underlines the need for stronger action to reduce the consumption of sugar from fizzy drinks.

The analysis of the sugar and calories in sugar-sweetened carbonated drinks, conducted by the Action on Sugar campaign group and published in the BMJ Open, reveals that the average 330ml can contains more sugar than an adult's recommended daily maximum intake of 30g (equivalent to 7.5 teaspoons), with some containing over 52g (12 teaspoons).

FGDP(UK) is supporting the authors' calls for further steps to be taken to cut the amount of sugar consumed from fizzy drinks in order to reduce the incidence of obesity, type 2 diabetes and dental caries.

The Faculty's Dean, Dr Mick Horton, said:

“The recent news that some manufacturers and supermarkets are reformulating their soft drinks ranges is welcome, and shows that the Sugar Tax is working even before its implementation. However the fact that the average fizzy drink contains more sugar than an adult should consume in an entire day, and three-quarters of them contain more than a child's recommended maximum, proves they simply cannot form part of a healthy and balanced diet, and stronger action is needed.

“Further restrictions on advertising of high sugar drinks, and a ban on price promotions, would help stop tens of thousands of children having to be hospitalised to have their teeth extracted, and if the government makes reformulation to under 5g of sugar per 100ml mandatory, the savings to the NHS will far outstrip the tax foregone, and more importantly the nation’s health will be improved.”

Notes to editors

1.The Faculty of General Dental Practice (UK) is based at the Royal College of Surgeons of England. It provides services to help those in general dental practice raise standards of patient care. It does this through standards setting, providing education courses and assessments, CPD, policy development, research and publications. Membership of FGDP(UK) is open to dentists and other registered dental professionals.

Stark new figures from the Obesity Health Alliance, released on World Obesity Day, show a looming significant weight gap between the poorest and wealthiest primary-school aged boys living in England. Three in five (60%) of the most deprived boys aged 5-11 are predicted to be overweight or obese by 2020, compared to about one in six (16%) of boys in the most affluent group [1].

The most deprived girls didn’t however show the same trend, and are projected to have similar obese and overweight prevalence rates to their more affluent counterparts with an average of 1 in 5 girls predicted to be obese or overweight by 2020.

Eating or drinking too much sugar is a key reason for consuming extra calories and therefore a cause of obesity. Sugar currently makes up 13% of children’s daily calorie intake, while the official recommendation is no more than 5% [2]. This is why the Obesity Health Alliance fully supports the Government’s Soft Drinks Industry Levy, which is an important step to help make our children healthier. The alliance is also calling on food manufacturers to comply with the Government’s programme to reduce the sugar in food eaten often by children and wants to see loopholes closed to protect children from exposure to junk food marketing online and on TV.

Robin Ireland, Chief Executive at Health Equalities Group and member of the Obesity Health Alliance, said: “These stats also illustrate an obvious gender gap with boys, especially those from the most deprived areas, much more likely to be obese. Whilst it is difficult to comment on exactly why this happens, there could be a number of reasons including girls usually being more conscious about their physical appearance, and boys being more brand loyal and therefore susceptible to the billions of pounds spent on marketing to children through brand characters and sports stars. Either way, this area needs a lot more attention.”

“From a young age, children are developing a taste for high sugar, salt and fatty foods that is difficult to break once established and as a nation, we all have a responsibility to help shape children’s diets.

“Sugary drink consumption levels tend to be highest among the most disadvantaged children who are hit hardest by obesity and tooth decay. The health gains from the soft drinks industry levy will be biggest for our most deprived children.”

Obese children are around five times more likely to become obese adults, and obese adults are more likely to develop serious health conditions such as Type 2 diabetes, cancer, liver and cardiovascular disease, and associated mental health problems [3] which all have a devastating impact on millions of lives.

Chris Askew, Chief Executive at diabetes UK, said: “Obesity is a major risk factor in developing Type 2 diabetes, and Type 2 accounts for 9 out of 10 diabetes cases. Treating diabetes and its complications already costs the health service £10 billion a year and the rising cost is placing huge pressure on the NHS.

“Not taking action now will result in the NHS forking out monumental amounts of money for largely preventable conditions. This is why it’s so important to implement the Soft Drinks Industry Levy, manufacture healthier food, and close the loopholes of junk food marketing to children today, so our future health, workforce, and NHS can stand a chance tomorrow.”

Weight predictions for 5-11 year old boys in least and most deprived groups in England

Males

Actual data

Modelled data

2013

2014

2015

2016

2017

2018

2019

2020

Least deprived (IMD Q1)

Overweight

13%

13%

13%

12%

12%

11%

11%

10%

Obesity

11%

10%

9%

9%

8%

7%

7%

6%

Healthy Weight

76%

77%

78%

79%

80%

81%

82%

83%

Most deprived (IMD Q5)

Overweight

14%

15%

15%

16%

16%

17%

17%

17%

Obesity

27%

29%

31%

34%

36%

38%

41%

43%

Healthy Weight

59%

56%

53%

51%

48%

45%

42%

40%

Further information:

This modelling was done by UK Health Forum. For more details, please contact Laura Webber,
This e-mail address is being protected from spambots. You need JavaScript enabled to view it.

[1] The analysis used existing figures of the number of children aged 5-11 who are obese, overweight and a healthy weight, categorised by level of deprivation, and modelled future trends. The data used were on childhood obesity prevalence from 2008 to 2014 taken from the Health Survey for England. These data were categorised by the factor, Index of Multiple Deprivation (IMD). IMD has five levels, with level 1 being least deprived and level 5 being most deprived.

Projections were made on these data using the calibration measure of uk90 data. The projections were made for the ages of 5-11, with a start year of 2008 and stop year of 2020.

[3] Simmonds, M., et al. (2016). ‘Predicting adult obesity from childhood obesity: a systematic review and meta-analysis’. Obesity reviews: an official journal of the International Association for the Study of Obesity’. 17(2): 95-107.

[4] IMD is the Index of Multiple Deprivation set out by the Department for Communities and Local Government.

1. The Obesity Health Alliance (OHA) is a coalition of over 30 leading health charities, campaign groups and Royal Medical Colleges who have joined together to fight obesity. http://obesityhealthalliance.org.uk/

2. The membership of the OHA currently comprises: Academy of Medical Royal Colleges, Action on Sugar, Association for the Study of Obesity, British Liver Trust, British Association of Sport and Exercise Medicine , British Heart Foundation, British Medical Association, British Obesity and Metabolic Surgery Society, British Society of Gastroenterology, Cancer Research UK, Children's Food Campaign, Children’s Food Trust, Diabetes UK, Faculty of Public Health, Faculty of Sport and Exercise Medicine, Health Equalities Group, Institute of Health Visiting, Jamie Oliver Food Foundation, National Obesity Forum, Men's Health Forum, Royal College of Anaesthetists, Royal College of General Practitioners , Royal College of Nursing , Royal College of Physicians, Royal College of Paediatrics and Child Health , Royal College of Obstetricians and Gynaecologists, Royal College of Psychiatrists, Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Royal Society of Public Health, Society for Endocrinology , UK Health Forum, World Cancer Research Fund UK.

3. The statement has been issued on the behalf of the Obesity Health Alliance steering group, which comprises of: British Heart Foundation, British Medical Association, Cancer Research UK, Children’s Food Campaign, Diabetes UK, Faculty of Public Health, Royal College of Physicians, Royal College of Paediatrics and Child Health and UK Health Forum.

This document, issued jointly with the Public Health Collaboration, has achieved Worldwide coverage over the past week. It was co-authored by Aseem Malhotra, NHS consultant cardiologist and NOF adviser, David Haslam, GP Watton-at-Stone, Sam Feltham, director of the Public Health Collaboration, David Unwin, GP Southport, and Shamil Chandaria, Patron, NOF, Jason Fung, , Nephrologist and Chief of the Department of Medicine, The Scarborough Hospital, Toronto, Canada, James DiNicolantonio, Cardiovascular Research Scientist Saint Luke's Mid America Heart Institute, Trudi Deakin, Dietitian and best selling author, Caryn Zinn Dietitian, Auckland, New Zealand, and Peter Brukner, OAM, MBBS, FACSP, FACSM, FASMF, FFSEM; specialist sports and exercise physician . No funding was sought or received for this report. The document was supported and peer reviewed by an International expert panel[i][i].

Historical context

The approach described in the document is nothing new, and the wording is deliberately phrased in respect to Hippocrates, the Father of Medicine who recommended ‘rich foods’ to stay thin, including fatty meats, especially grassfed animals. The arguments surrounding fats and carbohydrate have been vigorous ever since. The treatment of diabetes in particular has been controversial over many centuries. In the 17th century physicians such as Thomas Willis considered diabetes to be a disorder of the kidneys which leaked sugar; treatment was to replace the lost sugar with a high sugar diet. In the late 18th century John Rollo defined the underlying cause of diabetes as being the gastro-intestinal tract by varying macronutrients in the diet, and boiling down 24 hour urine specimens to measure the sugar therein; the lower the starch in the diet, the less sugar he found in the urine. Many great physicians espoused the low carb, higher fat approach over the next 150 years, culminating in classic texts such as Raymond Greene’s essential The Practice of Endocrinology which states that the diet for obesity is to avoid bread, flour, cereals, potatoes, sugar and sweets in favour of meat, fish and birds; green vegetables, eggs, cheese and certain fruit – a very similar method to that described in the report. There is a growing portfolio of recent evidence supporting the benefits of ad libitum low carbohydrate approaches.

Reactions to the report.

Predictably our document has polarised opinion, hence the need for this statement.

Negatives.

Professor Phillip James said: ”Unfortunately the human body developed in evolutionary terms the most duplicated rigorous and complex systems for keeping us from starvation so a glib series of one liners does not sort the obesity problem out - hence our failure so far.” and that the report “takes as read things like dietary cohort studies which are almost all fundamentally flawed with their measurement errors - particularly on fat% - and the failure to understand the individual , usually genetic, differences in responsiveness that we have seen in almost every biological response we have looked at.”

Pinki Sahota, Chair of ASO, on behalf of ASO said “The ASO, established [in](sic) 1967 is dedicated to the understanding, prevention and treatment of obesity. ASO is a scientific society and we support and promote an evidence based approach through the pursuit of excellence in research, education and practice. As such we do not endorse the content of the report as it contradicts current evidence based advice on healthy eating with a potential detrimental impact on public health”

Positives

Various other experts, however, have been generous in their support.

Professor Iain Broom wrote: “At long last there is some sense coming into dietary advice that may eventually lead to improved health, in particular tackling the double whammy of obesity and Type 2 Diabetes Mellitus. I totally agree with the document produced jointly by the NOF and the Public Health Collaboration” although correctly pointing out that we should have said ‘zero added sugar’, rather than ‘zero sugar’ as healthy fruit contain sugars.

Professor Robert Lustig, Professor of Paediatrics, Division of Endocrinology and Member, Institute for Health Policy Studies, University of California, San Francisco and President, Institute of Responsible Nutrition advised that: “this new National Obesity Forum and Public Health Collaboration guideline focuses on real food over processed food, and makes the case that the entire healthcare complex needs to relearn nutrition in order to be effective advocates for their patients. I couldn’t agree more.”

Professor Ian Banks, President of the European Men’s Health forum, praised the ‘superb report’.

Statement

The rest of the Board of the NOF wish to make it completely and transparently clear that they were not given the opportunity to see the document, or give any input into it and some members opinions differ from those specifically presented in the document. The Board has stated, regarding the document, "the NOF is a forum that welcomes debate and discussion, even when opinions differ or challenge widely held beliefs. This paper has some interesting arguments for future discussion, some of which are the opinions of the authors, and not all of the Board Members. Though individuals’ opinions differ within the Forum, as a group however, the NOF supports the principle of discussion and therefore the right of those named authors to produce an opinion paper based on their own views without prejudice or penalty. At the same time, the Forum recognises that NOF agents and associates, other Board Members and individual NOF members may have differing views from some points raised in this document and retain the right to those views also without prejudice or penalty within the freedom of a forum. For further information regarding this document, enquiries should be directed to the authors."

In most European countries around half of the population is now overweight or obese, and the percentage is set to rise further over the next decade. In the UK this could reach 71% by 2025

Associated healthcare costs are rising, with direct costs ranging from 1.5-4.6% of health expenditure in France to around 7% of healthcare spending in Spain

Lifestyle and behavioural education programmes are crucial—but obesity is also a medical condition that is hard to treat and is directly linked to other serious conditions

No European country has a comprehensive strategy for dealing with obesity. Experts say that only an integrated, multi-sectoral strategy is likely to cap the growth of obesity rates

Europe is facing an obesity crisis of epidemic proportions that threatens to place a tremendous burden on its healthcare systems. But policymakers appear divided over how to deal with the issue, according to Confronting obesity in Europe: Taking action to change the default setting, a new white paper published today (November 25th) by The Economist Intelligence Unit (EIU) and sponsored by Ethicon.

Projections from the World Health Organisation (WHO) indicate that the proportion of those who are overweight or obese is expected to rise further in most of western Europe over the next decade, reaching 71% in the UK, 76% in Iceland and 82% in Ireland, although the projections remain cautious owing to limitations in available data and reporting. Obesity puts strains on healthcare systems: the European Organisation for the Study of Obesity (EASO) found direct costs ranging from 1.5-4.6% of health expenditure in France to around 7% of healthcare spending in Spain.

Several of those interviewed for the report agree that European obesity policy on the national level has suffered from being fragmented among a number of government agencies, creating the need for better integration. "An effective strategy has to integrate a number of different sectors and different tools", said Roberto Bertollini, chief scientist and WHO representative to the EU.

Most policies looking to address obesity focus on lifestyle changes, including an emphasis on healthy diets and exercise. The majority of pan-European and even national obesity campaigns have been focused on healthy eating in schools and homes, better food labelling and incentives associated with healthy eating and exhortations for work-outs or “active kids” campaigns.

While lifestyle and behavioural education programmes have a crucial role to play in preventing obesity in healthy people, experts (including the American Medical Association) define obesity as a disease that is hard to treat. In order to rise to the challenge of obesity, policymakers need to acknowledge that those who are already obese are suffering from a medical condition for which lifestyle-based programmes are insufficient.

Zoe Griffith, head of programme and public health at Weight Watchers, highlighted the limitations of programmes aimed at lifestyle and behavioural change: "Education in schools, availability of healthy eating and restriction on marketing to children will go some way towards resetting our society, but what they are completely ignoring is the majority of the population who are overweight and obese and need treatment. It’s a very complex political and policymaking environment."

Martin Koehring, the editor of the report, summarised the report findings as follows: “Our report has highlighted that creating an environment that prevents obesity and discourages an unhealthy lifestyle is crucial. National approaches to obesity need to take into account two very different target populations. On the one side are healthy people, for whom prevention programmes are largely designed. On the other side are those who are already severely overweight and obese, for whom the traditional emphasis on behavioural change is generally ineffective. Only an integrated, multi-sectoral strategy is likely to cap the growth of obesity rates.”

Members of Parliament and their teams of local schoolchildren have put their nutrition knowledge to the test in a quiz within the House of Commons to promote healthy eating and hydration amongst young people.

Rob Flello (Chair of the All-Party Group for Adult and Child Obesity) and Steve Pound, MP for Ealing North teamed up with pupils from Featherstone Primary, Berrymede Junior School and Horsenden Primary for the quiz, which was chaired by London deputy mayor Lady Victoria Borwick.

The quiz was organised by the Eat Like A Champ programme, a Change4Life partner scheme designed to promote healthy diet and lifestyles amongst primary school pupils aged nine and 10 years. Pupils and MPs participated in six rounds of questions testing their knowledge of healthy eating, hydration and nutrition. The quiz was organised to coincide with the launch of National Obesity Awareness Week, which is led by the National Obesity Forum.

The Eat Like A Champ programme is run by Danone and was developed in collaboration with the British Nutrition Foundation.

The National Child Measurement Programme reported in December 2014 that 33.5 per cent of Year 6 children (aged 10-11) were considered either overweight or obese.

Professor David Haslam, Chairman of the National Obesity Forum, said:

“The findings of the National Child Measurement Programme were shocking but sadly not unexpected. There are too many young people who are not being exposed to the benefits of healthy eating and physical activity, particularly in deprived areas. Instead, they are largely sedentary and much of their diet consists of poor quality foods that are high in calories, sugars and trans-fats. This has consequences for children’s long-term health outcomes.

“We need to break this pattern and initiatives like Eat Like A Champ are vital in educating our young people about good nutrition and hydration habits. I’m very grateful to them for organising this event, and to all of the participating MPs and Lady Borwick. They’re not just being good sports – they’re helping to get across a really important message.”

Rob Flello MP, Chair of the All-Party Group for Adult and Child Obesity, said:

“Schemes like Eat Like A Champ and other Change4Life partner programmes are very important in helping young people have the best start in life. I hope the pupils taking part in today’s quiz enjoy being in Parliament and it’s important we use this opportunity to underline how crucial healthy eating is for young people.”

Adam Grant, Managing Director of Danone Ltd, said:

“Danone’s mission is to bring health through food and drink to as many people as possible. Therefore, I am delighted for Eat Like A Champ to support such an important initiative as NOAW. I am extremely proud of the Eat Like A Champ students who have demonstrated great enthusiasm and nutrition knowledge today. These children are true healthy eating champs.”

The National Obesity Forum is encouraging members of the public to commit to New Year’s Resolutions during National Obesity Awareness Week that will improve their health.

Podium.me is a new national platform for the voices of the under 20s across the UK.We broadcast a daily podcast on our site www.podium.me.uk and cover a huge range of subjects.This week, our army of student and teenage journalists have been asking young people about their attitudes to school dinners, fast food, and the right to be fat.It makes interesting listening, and we welcome feedback and debate via twitter podiumme and facebook podium.me

Although US children are viewing fewer " unhealthy " sugary, fatty foods advertised on TV, University of Illinois researchers have found that advertisers have increased advertisements for " fast foods "! They cite recent research showing that children watching cartoons consumed 45% more snacks when they were exposed to food ads. The food industry has, expectedly, repudiated the findings whilst noting that parents need to be aware that junk foods still feature heavily in TV ads. However, it took the opportunity to announce that it had developed new uniform nutrition criteria for foods that can be advertised to children.

Since the criteria will not go into effect until 2014, US parents concerned for their children's health still must await years for proof that " self-regulation" by commercial interests works. Unfortunately it would appear that the UK government is still adopting a similar non-regulation/legislative approach.

In a leading article for the peer review journal The Archive of Disease in Childhood, a leading UK paediatrcian, Professor Mary Rudolf from Leeds, questions whether enough is being done to identify babies most at risk of becoming obese. She proposes an Obesity Risk Tool [ORT]. Quite apart from the logical reversal of traditional criteria for weight faltering [namely to identify infants rising through 2 centiles/being above the 98th centile] further clear indications such as parental BMI, mother's gestational weight gain and the child's birthweight should be taken account of. She advocates that the ORT becomes an indispensible item in a primary healthcare workers armoury.

Producing a dependable ORT is arguably the most important innovation in reducing/preventing childhood obesity. The only long-term strategy in the country's fight against obesity is to fix it at source - focussing on the year[s] before/during pregnancy, birth and the child's very early years. Hopefully, the UK Department of Health will fully recognise this when publishing its obesity strategy later this year.

The failure of new obesity drugs to meet USA Federal Drug Administration [FDA] safety demands is preventing new approvals in obesity therapies. This has left Orlistat - and its over-the-counter version, Alli - as the only long-term therapy approved in Europe and the US . The FDA states that more safety evidence must be provided and both Lorquess and Qnexa have challenging paths to approval. It is not all bad news however. Novo Nordisk is now attempting to establish a higher dose of Victoza diabetes drug as a viable weight-loss drug for non-diabetics. Victoza's mechanisim avoids centrally acting side-effects that have been the cause of recent drugs withdrawals. Pivotal trials are scheduled to begin in the Autumn. [source Datamonitor]

Conservative members of the Welsh Assembly have criticised the Assembly for not using pharmacies to ease GP burden. With 20% of the population obese only 2% offer weight management services and none offer cholesterol testing. According to the Conservative health spokesman, Darren Millar AM, it would also make economic sense to spread the burden, too, with £1bn budget cits facing NHS Wales. The Assembly has responded by stating that it is committed to increasing pharmacy services and is trialling two vascular screening projects in Porthcawl and Merthyr Tydfil. The studies include the provision of advice on healthy eating. [source: BBC WALES]

Tom Condliffe, pill a morbidly obese man [BMI 43], rx whose primary care trust [PCT] refused to fund his bariatric surgery, for sale has lost his Appeal to take his case to the Supreme Court though he may ask the court itself to consider his case on the basis that it raises issues of general public importance. His QC argued that the PCT disregarded the benefits of surgery but the PCT responded by stating that health authority bosses were entitled to make such decisions without taking into account non-clinical and social factors.

The NOF is bound to inquire what is the purpose of NICE [the National Institute of Clinical Execellence] if the courts are going to run a coach and horses through its guidance? Mr Condliffe, who has several co-mobidities brought about by his weight, qualified for surgery when he had a BMI 35.

Bristol researchers have found that the majority of families receiving letters offering them the chance to discuss their children’s significant overweight with a GP, failed to take it up. Only 47% consulted their GP and barely 15% who did ended up with any record of their child's weight in the GP’s notes. As well as parents finding it difficult to seek help from a health professional GPs also seemed reluctant to deal with an often embarrassing issue. [British Journal of General Practice]

Professor David Haslam, NOF chairman, believes that the research showed that better ways were necessary to motivate children and adults with weight problems into shedding the pounds. Sending letters to parents is a waste of time. It’s the duty of the healthcare professional, doctor or nurse, when they see a patient whose weight is putting their health at risk to seize the moment – the children’s lives could be at stake.

Several national supermarket chains have teamed up in Edinburgh to promote fruit & vegetables, doctor reformulate some of their own brand fruit & vegetable produce and swap fruit for chocolate at check-out. This could well be a “ feasibility study “ for a wider roll-out throughout the United Kingdom.

It sounds too good to be true – and hopefully it will become contagious across the country. The Scots would like to think that it’s a dramatic illustration of supply and demand and shows a seismic “ behaviour change “ shift in the nation: truth is, it may be more to do with falling in line with the coalition government’s “ responsibility deal **. But as they say in the trade, “ every little helps! “

** The “ responsibility deal “, aka nudging, won’t work by itself, according to the House of Lords Science and Technology Committee. The government has really to be prepared to use legislation to tackle obesity. NOF is very comforted to know that it’s not alone in sharing this view.

A US study has found that children whose parents were told that they were overweight were no more likely to lose weight than parents who were not told. The study’s conclusion is that perhaps school should concentrate efforts on making sure that lunches were healthier and increased use of physical activity.[Archives of Pediatric Adolescent Medicine: Aug 2001]

The biggest flaw in the study is that the schools did not tell the parents that their child was “ overweight “ or “ obese “ but simply gave them its BMI. Since parents in general have little concept of BMI, case is it any surprise if they gave the letters scant attention? To compound the issue, erectile the authors also state that, since the letters were sent home c/o child, they may never have been delivered in the first place!

GPs can access advice and tools to help their patients care for themselves instead of using NHS resources through a Self Care Forum launched this week.. The tools will allow GP to implement self care initiatives by giving them top tips, viagra 60mg reports, ailment research, white papers and case studies’.

In the latest bid to combat childhood obesity, symptoms more than 15, story 000 restaurants from 19 chains are to offer meals – defined as an entreé, store side and beverage – that must be under 600 calories and contain two or more servings. Burger King is leading the way with a full kid’s meal at 420 calories.

On the assumption that whatever happens in America will also happen here, this initiative is only to be welcomed. The basic menu must also offer at one other healthy item [200 calories or less] and all healthy items must be visibl promoted.

The Information Centre [IC] for Health and Social Care February 25th 2009, February 2009

The stark headlines -40% increase in bariatric surgery, 30% increase in hospital admissions for obesity and an 11% and 12% increase in boys and girls respectively since 1995 just how bad the obesity situation in England has become. Though NOF was quoted in by every national newspaper as being horrified at each statistic it has to be said, in the calmer language of this website, that it recognises the need for bariatric surgery when all other attempts at weight-loss have failed. Prevention must always be better than cure and NOF will continue to remind the government of this need.

There is a glimmer of hope. IC statistics which the press were less inclined to headline were that a greater proportion of adults were meeting guideline on physical activity, that a greater proportion of both adults and children were eating five portions of fruit a day and that the rise in childhood obesity appears to be flattening out. Regarding this latter finding, IC recognises that data in the next couple of years will be important in confirming whether this is a continuing pattern.

NOF welcomes the decision to allow Orlistat, the weight-loss drug, to be sold over-the-counter and has been working closely with GlaxoSmithKline [GSK] to ensure that its introduction to the market in May runs as smoothly as possible. The non-prescription pill is to be known as alli and is half the size of regular Orlistat medication [60mg]. It will be available for people of a BMI of 28kg/m. Dr David Haslam, NOF chair and clinical director, states:- ‚Research has shown that consumers are spending millions of pounds each year on fad diets, unproven ‚'miracle' ‚ pills and potentially unsafe weight-loss supplements. Medically proven licensed products give consumers the option of something which can genuinely support meaningful weight loss. For many, losing weight can become the catalyst to improvements in their overall health and self-esteem .

Department of Health & Department for children, schools and families February 12th 2009

Both NOF and its sister charity concerned at the level of childhood obesity in the UK, the Child Growth Foundation [CGF], are flabbergasted at this document. It recommends absolutely no routine measure whatsoever capable of identifying the early signs of pre-school unhealthy weight gain despite stating repeatedly how urgently obesity must be addressed in the UK. Both charities have consistently urged Government actively to make provision for picking up children at risk of piling on the pounds at an age when lifestyle messages may best be learnt by them. The best time is during the pre-school years and children‚ growth should be assessed at specific early years ages in the same way that there are agreed ages for vaccinations.